“The age of children in the study … coincides with what’s felt to be the sensitive period for speech and language development,” Cosetti said.
Unlike antibiotics, she explained, ear tubes “may provide immediate relief from hearing loss related to middle-ear fluid — the value of which may be difficult to quantify in the current study.”
To Sobol, the study “emphasizes the importance of creating an individualized approach to management.”
The trial included 250 children, ages 6 months to nearly 3 years, who had suffered recurrent middle-ear infections — at least three within six months, or four within a year.
Hoberman’s team randomly assigned them to have either an ear tube surgically placed or receive oral antibiotics whenever a new infection struck.
Kids given ear tubes also received antibiotics when a new infection arose — but by ear drop. If that didn’t work, they switched to oral antibiotics.
One potential advantage of ear tubes, Hoberman noted, is that they allow ear-drop antibiotics. That could reduce the risk of bacteria elsewhere in the body developing antibiotic resistance.
Over the two-year study, though, there was no clear advantage of ear tubes when it came to new infections, or antibiotic resistance.
The average rate of recurrent ear infection was around 1.5 per year in the ear-tube group, and 1.7 in the comparison group. Infections declined in the second year in both groups.
Children with ear tubes did spend fewer days on oral antibiotics, the study found.
But the two treatment groups showed no difference in the likelihood of harboring antibiotic-resistant bacteria in the nose or throat.
Still, Sobol pointed out, there were some other advantages in ear-tube group.
For one, they tended to remain infection-free longer before their first recurrence. They also generally had fewer days with infection symptoms — with the exception of drainage from the ear.
At the same time, Hoberman said, ear tubes carry risks, albeit small. During the procedure, there can be bleeding or reactions to the anesthesia. In the longer term, the tube can become blocked or cause structural changes in the eardrum.